Suboxone

Adult Dosing .

Dosage forms:  SL STRIP: 2 mg/0.5 mg, 4 mg/1 mg, 8 mg/2 mg, 12 mg/3 mg

Special Note

[prescribing info]

Info: strongly consider prescribing naloxone if risk of opioid overdose or accidental ingestion

[formulation clarification]

Info: not bioequivalent to other buprenorphine/naloxone products; comparable doses are:

[Suboxone or generic 2 mg/0.5 mg SL strip or generic 2 mg/0.5 mg SL tab]

Info: equivalent to Zubsolv 1.4 mg/0.36 mg SL tab

[Suboxone or generic 4 mg/1 mg SL strip]

Info: equivalent to Zubsolv 2.9 mg/0.71 mg SL tab

[Suboxone or generic 8 mg/2 mg SL strip or generic 8 mg/2 mg SL tab]

Info: equivalent to Zubsolv 5.7 mg/1.4 mg SL tab

[Suboxone or generic 12 mg/3 mg SL strip]

Info: equivalent to Zubsolv 8.6 mg/2.1 mg SL tab

opioid dependence

[induction tx]

Dose: 2 mg/0.5 mg-4 mg/1 mg SL x1, may incr. by 2 mg/0.5 mg-4 mg/1 mg SL q1-2h prn up to 8 mg/2 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2 mg/0.5 mg-4 mg/1 mg SL q1-2h prn up to 16 mg/4 mg/day on day 2, then may incr. by 2 mg/0.5 mg-4 mg/1 mg per day prn until sx stabilization; Start: when mild-moderate withdrawal sx present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL strip; consider single-ingredient buprenorphine product if long-acting opioid use

[maintenance tx]

Dose: 4 mg/1 mg-24 mg/6 mg buccally/SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2 mg/0.5 mg-4 mg/1 mg per day prn; Info: do not cut/chew/swallow SL strip; doses >24 mg/6 mg/day rarely more effective; taper dose gradually over several months to D/C

renal dosing

[see below]

renal impairment: no adjustment

HD: no adjustment; no supplement; PD: not defined

hepatic dosing

[induction tx]

moderate-severe impairment: avoid use; Info: consider single-ingredient buprenorphine product

[maintenance tx]

mild impairment: no adjustment; moderate impairment: not defined, caution advised; severe impairment: avoid use

Peds Dosing .

Dosage forms:  SL STRIP: 2 mg/0.5 mg, 4 mg/1 mg, 8 mg/2 mg, 12 mg/3 mg

Special Note

[prescribing info]

Info: strongly consider prescribing naloxone if risk of opioid overdose or accidental ingestion

[formulation clarification]

Info: not bioequivalent to other buprenorphine/naloxone products; comparable doses are:

[Suboxone or generic 2 mg/0.5 mg SL strip or generic 2 mg/0.5 mg SL tab]

Info: equivalent to Zubsolv 1.4 mg/0.36 mg SL tab

[Suboxone or generic 4 mg/1 mg SL strip]

Info: equivalent to Zubsolv 2.9 mg/0.71 mg SL tab

[Suboxone or generic 8 mg/2 mg SL strip or generic 8 mg/2 mg SL tab]

Info: equivalent to Zubsolv 5.7 mg/1.4 mg SL tab

[Suboxone or generic 12 mg/3 mg SL strip]

Info: equivalent to Zubsolv 8.6 mg/2.1 mg SL tab

opioid dependence (off-label)

[induction tx, adolescents]

Dose: 2 mg/0.5 mg-4 mg/1 mg SL x1, may incr. by 2 mg/0.5 mg-4 mg/1 mg SL q1-2h prn up to 8 mg/2 mg/day on day 1, then give equivalent total daily dose from day 1 on day 2, may incr. by 2 mg/0.5 mg-4 mg/1 mg SL q1-2h prn up to 16 mg/4 mg/day on day 2, then may incr. by 2 mg/0.5 mg-4 mg/1 mg per day prn until sx stabilization; Start: when mild-moderate withdrawal sx present and >6h after last short-acting opioid use or >24h after last long-acting opioid use; Info: do not cut/chew/swallow SL strip; consider single-ingredient buprenorphine product if long-acting opioid use

[maintenance tx, adolescents]

Dose: 4 mg/1 mg-24 mg/6 mg buccally/SL qd; Start: equivalent total daily dose on last day of induction tx, then may adjust by 2 mg/0.5 mg-4 mg/1 mg per day prn; Info: do not cut/chew/swallow SL strip; doses >24 mg/6 mg/day rarely more effective; taper dose gradually over several months to D/C

renal dosing

[not defined]

renal impairment: consider adult renal dosing for guidance

HD/PD: consider adult renal dosing for guidance

hepatic dosing

[not defined]

hepatic impairment: consider adult hepatic dosing for guidance